Acupuncture Research - Addressing Challenges with Sham Points, Point Specificity, & Numbering Through A myofascial line model
It is my aim to address several problems present in acupuncture research and provide viable solutions to future studies. Some of the most relevant challenges will be discussed relating to traditional points, sham points, point specificity and nomenclature. An anatomical foundation for point location and functions will be discussed in terms of point regions, myofascial lines and nerves. In regards to point specificity and nomenclature, a system will be presented that bridges traditional numbering with key anatomical findings.
Within TCM standardized point names provide a foundation for communicating about point location and function. While this method of numbering is useful for traditional acupuncturists, it does present problems for the scientific community and researchers. One such challenge is the implied effects on internal organs and the specific effects these points are said to have. While some of the point functions can be understood according to the effects on nerves, not all of the specific functions can be explained within a neurological model. Additionally, it is common to find variations in point locations between clinicians, textbooks and particular styles of acupuncture.
Numbering Points by Body Regions - The Taiwanese Model of Master Tung
One useful method to categorize points is to number them according to body regions. For instance, in the Taiwanese system of Master Tung, points are numbered according to their placement on the fingers, hands, forearms, upper arms, soles of the feet, legs, thighs, ears, head, face and torso. Points in the fingers are given the prefix 11, which is then followed by two numbers which designate a more precise point location. Similarly, points on the palms and hands are preceded by 22 followed by two more numbers. In the case of the points numbered 22.06 and 22.07, these are located between the fourth and fifth metacarpals, with 22.06 being located at the distal end of the metacarpals, and 22.07 at the proximal end of the bones. To speak generally of points located in these various regions I will use the traditional Tung nomenclature of 22.xx to designate points on the hands, but not the fingers, and points 33.xx to name points on the forearms. Points in the upper arm are designated with 44.xx, points in soles of the feet 55.xx, points on the dorsal aspect of the feet with 66.xx, points on the lower leg 77.xx, points on the thighs 88.xx, ear points with 99.xx, head points with 1010.xx, dorsal torso points with DT, and ventral torso points with VT.
This method of numbering also allows us to consider point functions based on anatomical, neurological, and myofascial features present in each of these regions. In areas like the hands and feet there is a higher concentration of sensory nerves eliciting stronger needle responses. Regions like the thigh, back and abdomen produce less needle intensity and have a lower concentration of afferent nerves.
Points within any given region will often produce similar responses, and differences within the region can be understood according to nerves, myotomes, dermatomes and myofascial lines. For instance, points on the anterior arm with the numerical prefix of 33.xx will effect the radial nerve in the area of the lung meridian, the median nerve along the pericardium meridian, and the ulnar nerve along the heart meridian. Similarly, this region of the forearm will influence two fascial lines. The Superficial Front Arm Line (SFAL) covers most of the anterior forearm, while the Deep Front Arm Line transverses through the cubital region. Considering the nerves and myofascial lines allows for both electrical and mechanical point specific functions, and resolves some of the challenges of only adopting a neurological model for point functionality.
Points on the Arms and Hand for Back Pain
There are a variety of points on the hands and arms for treating back, neck and spinal pain. While some of these point functions can be understood according to what nerve regions and myotomes are influenced by acupuncture, many specific point applications do not fit the neurological model. Through considering myofascial lines these point functions can be better understood and related to mechanical factors and force transmission through the myofascial system.
Notice in the above image of the front arm lines that the latissimus dorsi is included in the SFAL. As the latissimus attaches to the humerus, we can make an anatomical association between the arms and low back region where the latissimus attaches along the poster pelvic crest. This direct connection between points on the arms and hands, and the region of the lower lumbar myofascia, provides a working model for why points on the hands and arms can be so effective for lumbar disorders. Points on the hands and arms that are used for lumbar pain include: 22.04, 22.05, 22.06, 22.07, 22.08, 22.09, 33.04, 33.05, 33.06, 33.08, 33.09. Traditional points used for lumbar pain include SI 3, LI 4, Yao Tong Xue, Luo Zhen, and SJ 5.
Sham Points & the Myofascial Lines
Many studies have failed to find a difference between sham points and traditional points for a variety of disorders. In considering sham points in close location to traditional points, we can conclude that in many cases the same nerves and myofascial lines will be stimulated by the needles. When controls are set within specific anatomical regions and for needling techniques, we will likely observe similar effects when the same myofascial lines and nerves are involved. However, if sham points are selected within a different myofascial plane, and along a different nerve region or myotome, it would fail to be an adequate control. A systematic review or future studies involving traditional points, sham points, and which account for nerves, myofascial lines, and body regions would be insightful.
Future research should first maintain controls within specific body regions such as the hands, feet, arms and legs, and could be referenced with the Master Tung numerical system. Once points are selected for according to these specific body regions, additional controls can be set along the myofascial lines and nerve pathways. A primary hypothesis with these research parameters would be that traditional and sham points in the same region, in the same myofascial line, and effecting the same nerves will produce similar results. Additional controls could compare results within one region but on different myofascial lines, such as needling points in the hands and selecting for the Superficial Front Arm Line (SBAL) and the Deep Back Arm Line (DBAL). Such a study could isolate differences for treating neck pain between the point groups 22.03 and 22.06 on the SBAL, and 22.08 and 22.09 on the DBAL.
As both groups of points are on the hands, a control based on this body region can be maintained. The points 22.08 & 22.09 located on the DBAL will influence this myofascial plane, the ulnar nerve, and muscles and structures connected to the scapularis, rhomboids and levator scapulae. The points 22.03 and 22.06 also located on the hand will influence the SBAL and will effect the trapezius and connecting structures.
Controlling for Fascial Lines & Measuring Differences Between Body Regions
Many points on the SBAL and in different body regions treat neck, back and spinal pain. The point group 22.06 & 22.07 located on the hand are effective for certain patterns of lumbar pain, as are the point groups on the arm 33.08 & 33.09. Both of these point groups are also located on the TW meridian and the SBAL. Studies comparing these two points groups may lend additional information about how hand and arm points on the SBAL differ or are similar in their therapeutic effects.
Generally, points on the hands produce a stronger twitch response and are better for acute conditions, but more centrally located points like 33.04 - 33.06 tend to be better for more chronic patterns. As both groups of points are indicated for lateral line sciatica, we may find each group produces similar responses. Additionally, sham points within this myofascial line, and between the two point groups, may produce similar reactions as they are also on the SBAL and will influence similar nerve pathways.
Learn more about these systems and how Tung's points relate to myofascial lines and Medical Acupuncture.